MEDICARE: DENNISE ANNE VICENCIO FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	833543	NV
2	363LF0000X	Family Nurse Practitioner	11038102	FL

General Provider Information

NPI Number	:	1659176758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNISE ANNE VICENCIO FNP-BC

Provider Business Mailing Address
First Line	:	2120 HOYT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3939
Country	:	US
Telephone Number	:	702-358-9263
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 S RAINBOW BLVD STE 17
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-2970
Country	:	US
Telephone Number	:	702-473-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2025
Last Update Date	:	12/11/2025

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